New York State Health Insurance Program
United Healthcare: Payments for High-Cost Wheelchairs The New York State Health Insurance Program (NYSHIP) provides health insurance coverage to active and retired State, participating local government and school district employees and their dependents. The Empire Plan (Plan) is the primary health benefits plan for NYSHIP. The Department of Civil Service (Department) contracts with United HealthCare (United) to process medical claims for the Empire Plan (Plan).
We examined $2.9 million in claims paid to four suppliers for 79 high end wheelchairs provided to people covered by the Plan. On average, these providers were paid $37,000 each for these wheelchairs; resulting in an average gross profit of more than $20,000 per chair. This situation occurs primarily because the State, and the Health Insurance Council that oversees the NYSHIP program, has designed the Plan to have few restrictions on payments made for high cost wheelchairs and accessories. In addition, United does an inadequate job of monitoring claims to ensure that suppliers comply with the few restrictions that do exist, including making sure that prices are accurate and discounts are appropriate. Our review disclosed overpayments to providers totaling $128,238 simply because claims exceeded contract limits.
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